This is an application for a K08 award for Dr. Holena, a trauma surgeon and surgical intensivist at the University of Pennsylvania, Philadelphia. Dr. Holena is establishing himself as an early stage investigator focused on reducing mortality attributable to cardiac and pulmonary complications after traumatic injury. This award allow Dr. Holena to accomplish the following goals: (1) become an expert at clinical research in cardiopulmonary complications after injury; (2) implement advanced quantitative analyses with large datasets; (3) conduct qualitative studies to measure exposures not captured in existing data sources (4) develop a career as an independent clinical investigator. Dr. Holena and his expert multidisciplinary mentorship team will test the potential for Failure to Rescue theory to help identify those processes of care which are likely to result in the greatest reductions in mortality attributable to cardiac and pulmonary complications in injured patients. Cardiac and pulmonary complications comprise 47% of the major complications after injury and are responsible for 56% of potentially preventable deaths. Efforts to reduce mortality attributable to these events have historically focused on reducing rates of specific complications, but recent evidence suggests that center- level variations in mortality are not associated with rates of complications but rather with the likelihood of death following complications, or Failure to Rescue (FTR). The central hypothesis this proposal is that patient and center factors will explain some but not all of the variation in rates of cardiac complications, pulmonary complications, FTR after cardiac complications (FTRC), and FTR after pulmonary complications (FTRP) in injured patients and that specific processes of care at individual trauma centers can be identified which contribute to this variation. Dr. Holena's mentored research will: (1) determine the patient factor associated with cardiac complications, pulmonary complications, FTRC, and FTRP; (2) identify center factors associated with these outcomes and define the relative contributions of patient and hospital factors to each of these metrics; and (3) define specific processes of care associated better than expected center-level performance with in these metrics. Dr. Holena's mentor and advisory committee will ensure his attainment of benchmarks in research, publication, and career development through regular meetings and review. The conduct this research will allow the Dr. Holena to contribute significantly to knowledge of mortality attributable to cardiopulmonary complications after injury, mature as an investigator, and prepare to successfully compete for future independent research funding.